Tri-City's heart-case death rate 2nd in '06

State report cites bypass procedures

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Tri-City Medical Center in Oceanside had the state's second-highest death rate for heart-bypass surgery in 2006, and two local doctors were among the worst performers of the procedure, according to a report released today.

The statewide mortality rate for adult patients receiving the most common form of the surgery was 2.22 percent, down from 3.08 percent in 2005, said the Office of Statewide Health Planning and Development.

Tri-City's rate was 7.91 percent, with six of 87 patients dying within 30 days of their surgeries.

Death rates for the 10 other local hospitals included in the annual state report ranged from none at Scripps Green Hospital in La Jolla to 3.81 percent at Scripps Mercy Hospital in Hillcrest and Chula Vista.

The percentages were adjusted to account for patients' age, weight, chronic diseases and other factors that increase the risk of death from heart surgery.

State health officials said it takes two years to report the rates because they need to search death records for patients who die after leaving the hospital. They said consumers should consider the report's findings when seeking heart treatment.

The heart-bypass analysis comes less than three months after the same state agency cited Tri-City for having higher-than-average death rates for craniotomies and treatment of acute stroke and gastrointestinal hemorrhage.

Tri-City's leaders called their 2006 heart-bypass record a statistical “anomaly.” They said their hospital's death rate was well within range of the state average during the several years before and after.

Tri-City officials and outside consultants reviewed all six cases that resulted in death and found no major flaws, said Dr. Richard Burruss, head of the hospital's medical staff.

“Clearly, it wasn't reflective of the outstanding care that was being given to those patients,” he said.

Burruss acknowledged that two cases did share a common factor that might have contributed to the final outcome: They were handled by physicians who performed few heart-bypass surgeries. He declined to identify the doctors, but said both are no longer doing surgeries at Tri-City.

Studies have shown that death rates tend to be higher among patients treated by low-volume physicians.

“There is a practice-makes-perfect association,” said Joe Parker, director of health care outcomes for the Office of Statewide Health Planning and Development.

In the new report, state officials singled out Dr. John Young of Tri-City, Dr. Jolene Kriett of UCSD Medical Center and six other thoracic surgeons in other parts of California for worse-than-expected performance.

Young's risk-adjusted mortality rate was 24.43 percent in 2005 and 2006 because two of his five patients died. Kriett's 100 percent rate resulted from the death of the only adult patient on whom she performed a heart bypass during the two-year period.

Young said both of his patient deaths involved extenuating circumstances. He said one patient had an adverse reaction to aprotinin, a blood-clotting medicine that was later pulled from the market, while the other suffered complications from mistakes made by other hospital staffers after surgery.

He said Kriett has performed more than 10,000 heart procedures over the past 25 years, and that complicated cases are referred to her because of her experience. Nearly all of Kriett's work in recent years has involved pediatric patients, he added.

In the sole adult case, Kriett operated on a patient who arrived at the hospital in cardiac arrest and received an angioplasty before being sent to surgery in a final effort to save her life, Jamieson said.

“You can't judge somebody's reputation on the basis that they put their neck out and tried to save the life of one dying patient,” he said. “Something like this is a terrible slap in the face.”

California physicians performed 15,036 heart-bypass surgeries in 2007, down about 6 percent from 15,927 in the previous year. The change continued a decade-long trend of avoiding bypass operations in favor of doing less-invasive angioplasty procedures, which use catheters to insert tiny balloons and stents into clogged arteries to restore healthy blood flow to the heart.